一位65歲女性以進食後上腹痛表現

A 65-Year-Old Woman with Postprandial Epigastric Pain

吳美珠(Mei-Chu Wu)；王乙茜(Yi-Chian Wang)；蘇家弘(Chia-Hung Su)；蔡東霖(Dong-Lin Tsai)；陳芝文(Chih Wen-Chen)

進食後上腹痛 ； 胃食道逆流 ； 橫膈膜裂孔疝氣 ； postprandial epigastric pain ； gastroesophageal reflux ； hiatal hernia

安泰醫護雜誌

30卷1期（2024 / 06 / 01）

29 - 41

繁體中文;英文

進食後上腹痛臨床上會先想到膽結石及消化性潰瘍等疾病。本個案65歲女性，體型肥胖，進食後上腹部疼痛近10天入院求治，伴隨胸悶、胃酸逆流及呼吸困難等症狀，懷疑胃潰瘍及胃食道逆流，安排胃鏡檢查發現巨大的滑脫性橫膈膜裂孔疝氣併胃體扭轉，即時於胃鏡下進行胃部復位，進一步安排腹部電腦斷層確診為橫膈膜裂孔疝氣併腸繫膜軸性胃扭轉，為避免引發缺血性壞死、穿孔導致敗血症而危及性命，安排個案進行腹腔鏡裂孔疝氣修補及胃底摺疊手術，手術後口服氫離子幫浦阻斷劑治療，經由醫師、專科護理師及營養師跨團隊照護下治癒出院。建議中老年女性、肥胖者、進食後上腹痛、胃食道逆流症狀經藥物治療後未改善，應及早將橫膈膜裂孔疝氣納入鑑別診斷，早期診斷與及時治療，避免疾病進展及降低併發症與死亡率；並於返家前衛教改善生活習慣、體重管理，預防因肥胖疝氣復發或共病發生。

Postprandial epigastric pain is commonly caused by biliary colic, peptic ulcers, and Gastroesophageal Reflux Disease (GERD). We present a 65-year-old obese female with a 10-day history of postprandial upper abdominal pain presenting with chest tightness, dyspnea, and gastric acid reflux. Initial differentials included gastric ulcer and gastroesophageal reflux. However, esophagogastrodudenoscopy (EGD) revealed a giant hiatal hernia with torsion of the gastric body and gastric repositioning. Abdominal Computed tomography revealed hiatal hernia and mesenteroaxial volvulus. Because volvulus may lead to gastric ischemic necrosis, perforation, and sepsis, the patient received urgent laparoscopic hiatal hernia repair and fundoplication and was placed on oral proton pump inhibition following surgery. The patient received multidisciplinary team care including the general surgeon, nurse practioner, and nutritionist. Postoperative recovery was smooth and the patient was discharged for clinic follow-up. For middle-aged to elderly, obese females presenting with postprandial epigastric pain and gastroesophageal reflux refractory to drug treatment, hiatal hernia should be included in the differential diagnosis. Early diagnosis and timely treatment may prevent disease progression and reduce morbidity and mortality. Health education, including lifestyle changes, and weight management may also help prevent hernia recurrence and obesity-related complications.